US7666893B2 - Method for treatment of neurodegenerative disorders - Google Patents

Method for treatment of neurodegenerative disorders Download PDF

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US7666893B2
US7666893B2 US11/805,624 US80562407A US7666893B2 US 7666893 B2 US7666893 B2 US 7666893B2 US 80562407 A US80562407 A US 80562407A US 7666893 B2 US7666893 B2 US 7666893B2
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imidazolecarboxylate
methyl
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administering
treatment
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US20070276021A1 (en
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Elaine A. Delack
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MedDEV Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/24—Antidepressants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia

Definitions

  • the present invention relates generally to methods for the treatment of multiple sclerosis and other neurodegenerative diseases, disorders and conditions, and more particularly to treatment of such multiple neurodegenerative diseases, disorders and conditions by administration of an alkyl ester of imidazole carboxylic acid in order to maintain the intracellular/extracellular osmolyte gradient in the central nervous system (CNS).
  • CNS central nervous system
  • MS Multiple sclerosis
  • MS is a neurodegenerative disease of the central nervous system resulting in sensory and motor dysfunction, visual disturbances, cognitive and memory impairment, and bowel and bladder dysfunction.
  • Multiple sclerosis is the most common neurological disorder of young adults with the onset of symptoms generally occurring between the ages of 20 and 50.
  • the disease According to the National Multiple Sclerosis Society, the disease currently affects more than 400,000 individuals in the United States with 200 new cases diagnosed every week and more than 2.5 million people worldwide. Data from the recent Zogby International poll suggests that these numbers are underestimated and that multiple sclerosis affects 2.87 million individuals in the United States and more than 6.25 million worldwide. Over 70% of all multiple sclerosis patients are too disabled to remain in the workforce due to symptoms of fatigue and cognitive dysfunction.
  • a recent study by Duke University estimates annual direct and indirect costs of MS in the United States to be $9 billion; this makes it second only to Alzheimer's disease in economic impact.
  • MS neurological diseases and disorders that may stem from possibly similar degenerative mechanisms. Examples include, but are not limited to, fibromyalgia, memory impairment, and certain forms of depression and erectile dysfunction.
  • the present invention has solved the problems cited above, and is a method for treating neurodegenerative diseases by addressing the intracellular/extracellular osmolyte gradient in the central nervous system.
  • neurodegenerative diseases, disorders and conditions that can be treated by the method of the present invention include, but are not limited to, multiple sclerosis, fibromyalgia, memory impairment, erectile dysfunction and depression.
  • the method comprises the step administering to a patient suffering from a neurodegenerative disease, disorder or condition, an effective amount of at least one alkyl ester of imidazole carboxylic acid.
  • the at least one alkyl ester of imidazole carboxylic acid is administered in an amount sufficient to maintain the intracellular/extracellular osmolyte gradient in the CNS within a substantially normal range.
  • the at least one alkyl ester of imidazole carboxylic acid may be methyl 4-imidazolecarboxylate.
  • the methyl 4-imidazolecarboxylate may be administered orally, by inhaler, by injection, or by transdermal application, or combinations thereof.
  • the dosage range of the methyl 4-imidazolecarboxylate may be from about 0.01 mcg to about 3.0 mcg per day, with a preferred dosage range being from about 0.1 mcg to about 0.2 mcg per day.
  • the present invention provides a method for treatment of multiple sclerosis and other neurodegenerative diseases, disorders and conditions by one or more the administration of alkyl esters of imidazole carboxylic acid, preferably methyl 4-imidazolecarboxylate, in amounts sufficient to maintain the intracellular/extracellular osmolyte gradient in the CNS.
  • the present invention is not limited to the treatment of MS, and that the invention includes the treatment of other neurodegenerative diseases, disorders and conditions, including, without limitation, fibromyalgia, erectile dysfunction, memory impairment and depression.
  • the present invention teaches the administration of a methyl ester of imidazole carboxylic acid, specifically methyl 4-imidazolecarboxylate, in an amount sufficient to maintain the intracellular/extracellular osmolyte gradient and prevent the self-degeneration of the oligodendroctyes and/or neurons and/or neuronal cells in the central nervous system in multiple sclerosis patients.
  • the extracellular fluid provides a bi-directional communication between the astrocytes and the neurons.
  • the information highway between the pre and post synaptic neurons and the surrounding astrocytes is called the tripartite synapse and the information is carried by calcium and sodium ion transporters in the extracellular fluid [Fields, R. D. April 2004; Perea & Araque, 2005].
  • the movement of the ions in the extracellular fluid is dependent on entropy.
  • Entropy is the movement of all spontaneous reactions toward a condition of greater randomness or greater disorder. Entropy involves the formation of a kosmotropic (highly structured environment) that dissociates to a chaotropic (disorderly environment) [Szent-Gyorgy, March 2005].
  • the side-chain carboxylate in proteins plays an integral part in forming and maintaining the extracellular medium in the tripartite synapse and the transmission of information via entropy.
  • the side-chain carboxylate groups (i.e. aspartic and glutamic acids) in proteins contain two oxygen atoms that are nearer than occurs between water molecules in bulk liquid water ( ⁇ 2.82 ⁇ ). This normally causes a high density water clustering around these groups due to the closeness of the water molecules as they hydrogen bond to these carboxylate oxygen atoms. Such hydrogen bonding induces a more negative charge on the carboxyl oxygen atoms leading to an increase in the carboxylate pK a .
  • the carboxylates form a higher density water network resulting in the sodium ions accumulating in the extracellular medium, whereas the potassium ions prefer a lower density water network and thus accumulate in the intracellular medium. This results in the concentration gradients of sodium and potassium in the extracellular and intracellular mediums respectively.
  • the formation of the higher density water networking by the carboxylates creates a temporary kosmotropic environment, but then as the sodium ions are attracted to the carboxylate synthesized by the neuron and oligodendrocyte, the sodium destroys the hydrogen bonds of the high density water network resulting in entropy. This randomization continues outward from the synapse through the extracellular fluid creating current that flows to the astrocytes.
  • the entropy current moves in the direction of the astroctyes because the carboxylates synthesized by the astrocytes have a high affinity for calcium ions and calcium is even more destructive to the hydrogen bonds formed between the carboxylates and water molecules. This results in even greater entropy around the astrocytes than around the neurons and oligodendroctyes [G. N. Ling, Life at the cell and below - cell level. The hidden history of a functional revolution in Biology , (Pacific Press, New York, 2001).
  • N-acetyl-L-aspartate (NAA) and N-acetyl-L-aspartylglutamate (NAAG) act as cellular water pumps that help to maintain the intracellular/extracellular osmolyte gradient independent of the extracellular solute composition or osmolarity. [Baslow, 1998].
  • NAA N-acetylaspartate
  • H2 receptor stimulation which has been postulated by this inventor to be deficient in MS, is necessary to maintain the proper water content in the brain. Impaired H2 receptor stimulation results in dehydration of the brain, creating a hyperosmolarity of the brain [Sharma et al, 1992]. This may account for the low levels of NAA in the brains of MS patients.
  • NAA N-acetyl-L-aspartylglutamate
  • Gliosis an overgrowth of astrocytes in a damaged area of the brain, is common in MS patients and other neurodegenerative diseases such as Alzheimer's, amyotrophic lateral sclerosis, mixed dementia, vascular mediated dementia, depression, cerebral stroke, traumatic brain injury and aging (Kashon et al, 2004; Tateishi et al, 2006).
  • Glial fibrillary acidic protein (GFAP) is a marker for astrogliosis. Cognitive function has been inversely associated with GFAP in the occipital, parietal and temporal lobes.
  • GFAP levels are significantly greater in individuals diagnosed with Alzheimer's disease, mixed dementia, and vascular mediated dementia as compared to non-demented individuals (Kashon et al, 2004). GFAP levels are significantly higher in layer I of the dorsolateral prefrontal cortex in elderly patients with major depressive disorder than in controls (Davis et al, 2002). This increase in astrocytes could result in increased uptake of NAA and increased production of glutamate resulting in the decreased levels of NAA and increased levels of glutamate that are seen in MS patients and other neurodegenerative diseases. Glutamate itself can bind an ammonium ion to form glutamine, a second amino acid. Glutamine can then be recycled to regenerate glutamate.
  • Glycogenolysis and synthesis of glutamate and glutamine from glucose are both metabolic processes restricted to astrocytes [Hertz et al, 2004].
  • active lesions and large lesions have increased glucose utilization, increased glutamate concentration and decreased NAA concentration as compared to healthy subjects [Schiepers et al, 1997].
  • Glutamate is neuroexcititory and elevated levels can be neurotoxic.
  • the release of glutamate by astroctyes is stimulated by extracellular potassium and the release requires the presence of extracellular calcium and the influx (uptake) of the extracellular calcium [Simard & Nedergaard, 2004].
  • the rate of calcium uptake is increased when the concentration of the potassium is increased [Blaustein, 1975].
  • Osmotic myelinolysis is usually associated with hyponatremia [Kiline et al, 2002].
  • Osmotic myelinolysis is a demyelinating disorder that has similarities to multiple sclerosis, including cerebral white matter and pontine lesions that were hypo and hyper-intense on T1 and T2W sequences respectively [Chua et al, 2002].
  • T1 lesion hypointensity on MRI in MS patients in vivo strongly correlated with the neuronal apoptosis induced by cerebrospinal fluid from MS patients on neuron cultures [Cid et al, 2002].
  • Alcazar et al reported scientific findings that the CSF from primary-progressive MS patients induced neuronal damage to healthy normal cortical neurons in culture and that the neuronal cell damage was not due to tumor necrosis factor (TNF-a) molecules transundated from blood or IgG.
  • TNF-a tumor necrosis factor
  • the present invention hypothesizes that impaired intracellular/extracellular osmolyte gradient of the CSF in an MS patient may be the factor inducing the neuronal damage in vitro and in vivo.
  • Methyl 4-imidazolecarboxylate (C 5 H 6 N 2 O 2 ) has the following molecular structure:
  • the methyl ester group (—COCH3) is responsible for creating the high-density water networking necessary to maintain the intracellular/extracellular osmolyte gradient.
  • the oxygen atoms are in closer proximity than what normally occurs in bulk water. This creates a higher-density water clustering around these groups. (Water molecules hydrogen-bonded to these oxygens are closer together than they would be in bulk water.)
  • the deficient formation of the high-density water networking in the extracellular fluid and the deficient concentration of sodium ions in the extracellular fluid results in an efflux of potassium ions into the extracellular fluid which can result in death of the neuronal cell and oligodendroctye. Furthermore, the efflux of potassium ions into the extracellular fluid stimulates the release of glutamate from the astrocytes into the tripartite synapse. Glutamate, a carboxylate synthesized by the astrocytes, creates a high-density water network in the extracellular fluid around the astrocyte and attracts calcium ions to accumulate in the extracellular fluid around the astrocyte.
  • the increased extracellular potassium activates the calcium ion channels in the astroctye membranes resulting in the influx of calcium ions into the astroctye, which results in elevated cytosolic calcium levels in the astroctye.
  • Increased cytosolic calcium stimulates mitosis of astrocytes resulting in gliosis.
  • the increase in the number of astrocytes may result in an increase in the uptake of NAA, resulting in an overall decrease in the NAA levels in the CNS in MS patients.
  • the present invention seeks to maintain the intracellular/extracellular osmolyte gradient in the CSF of patients suffering from MS and other neurodegenerative disorders, by the administration of an alkyl ester of imidazole carboxylic acid methyl 4-imidazolecarboxylate is generally preferred, however, it is anticipated that other alkyl esters of imidazole carboxylic acid may also be suitable and effective.
  • the treatment composition may be administered by any suitable means, such as orally, or by transdermal application, injection or inhaler, to give just a few examples. Administration by transdermal application is preferable in many applicants, in that it provides significant advantages in terms of ease of use, and more consistent dosage levels.
  • the dosage range is suitably 0.01 mcg to 3.0 mcg per day, with the preferred dosage range being 0.1 mcg to 0.2 mcg per day.
  • transdermal application is generally the preferred mode for administering the methyl 4-imidazolecarboxylate, or other alkyl ester of imidazole carboxylic acid.
  • material suitable for transdermal application can be prepared using a 1:1000 dilution of methyl 4-imidazolecarboxylate CAS number 17325-26-7, available from Sigma-Aldrich Corporation), combined with a pluronic lecithin organogel transdermal penetration enhancing vehicle, with hydrochloric acid being added to maintain the pH of the solution that or below 3.
  • the resultant mixture may be dried and deposited on or applied to a suitable adhesive backing to form a transdermal patch, covered with quick release paper or other layer for protection prior to use.
  • transdermal delivery systems such as lipoderm and anhydrous transdermal gels, for example. It has also been found that a somewhat higher dosage may be needed in some instances, e.g., 0.3 mcg rather than 0.2 mcg when using a karayaoum/glycerin delivery system rather than a PLO gel, and it is anticipated that variations in optimal dosage may occur in using other delivery systems as well.
  • the dosage range for methyl 4-imidazolecarboxylate is suitably from about 0.01 mcg per day to about 3.0 mcg per day; negligible effect has been observed using dosages below the lower figure, while dosages about the upper figure (i.e., above approximately 3.0 mcg per day) tend to produce a negative cognitive effects, in a form of mental haziness or sleepiness.
  • dosages in the range from about 0.1 mcg to about 0.2 mcg per day have been found generally preferable, with some variation on a patient by patient basis.
  • a regimen of administering a suitable amount (typically 0.2 mcg) of the methyl 4-imidazolecarboxylate on a cyclic but non-daily basis was found to be particularly effective; in particular, a regimen of applying approximately 0.2 mcg once every three days (i.e., administering the compound one day, followed by a break of two days before the next administration) has been found especially effective for the majority of patients.
  • administering the material at other periodicities can also be effective, albeit generally to a somewhat lesser degree.
  • beneficial effects can be sustained by administering approximately 0.1 mcg every other day, or by administering dosages below about 0.1 mcg on a daily basis.
  • MS multiple sclerosis
  • the patient had no symptoms of MS and she was able to remain free of symptoms for the next 36 hours without applying the treatment of the present invention.
  • she reported that her MS symptoms were returning, she then applied 0.125 mcg methyl 4-imidazolecarboxylate via transdermal patch and her MS symptoms were alleviated within 30 minutes of applying the treatment.
  • She administered 0.125 mcg methyl 4-imidazolecarboxylate per day for next 2 consecutive days and was again able to remain free of all of the MS symptoms while wearing the transdermal patch containing the treatment dose and then remained free of symptoms for the following 2 days not administering the treatment.
  • the treatment of the present invention has successfully alleviated all of the MS symptoms plaguing this patient prior to the initiation of the methyl 4-imidazolecarboxylate, utilizing a dosing schedule of 0.2 mcg methyl 4-imidazolecarboxylate for one day followed by 2 consecutive days without administering treatment and then repeating such dosing schedule.
  • a 46-year-old female who has been suffering from multiple sclerosis (MS) for 21 years was treated in accordance with the method of the present invention.
  • Within 30 minutes of applying the first dose of 0.15 mcg methyl 4-imidazolecarboxylate via transdermal patch application all MS symptoms were alleviated.
  • the patient remained free of all MS symptoms with the administration of 0.15 mcg methyl 4-imidazolecarboxylate per day for the next two consecutive days.
  • the patient was able to remain free of MS symptoms for 36 hours following the two consecutive days of application of present invention without use of treatment. After 36 hours of not using the present invention treatment, the patient experienced left foot tingling. The patient then applied 0.15 mcg methyl 4-imidazolecarboxylate per day via transdermal patch for two consecutive days and all MS symptoms alleviated. The patient was able to remain free of all MS symptoms for the next 4 days without applying the present invention treatment. On the fifth day without treatment, left foot tingling returned, so the patient applied 0.15 mcg methyl 4-imidazolecarboxylate via transdermal patch and symptoms resolved immediately. The following 5 days the patient remained free of all MS symptoms without administering treatment of present invention.
  • the patient has continued to remain free of all MS symptoms utilizing a dosing schedule of 0.2 mcg methyl 4-imidazolecarboxylate applied via transdermal patch for one day and then without administering treatment for 2 consecutive days and then repeating such dosing schedule.
  • MS patients 2 female and 2 male, reported improvement in their MS symptoms i.e. improved bladder function, decreased fatigue, decreased tingling and numbness, improved balance, improved cognition and memory, improved walking ability, and improved sleep with vivid dreams, while being treated in accordance with the method of the present invention.
  • MS symptoms i.e. improved bladder function, decreased fatigue, decreased tingling and numbness, improved balance, improved cognition and memory, improved walking ability, and improved sleep with vivid dreams, while being treated in accordance with the method of the present invention.
  • Each patient has continued to maintain such improvements in their symptoms of MS by applying 0.2 mcg methyl 4-imidazolecarboxylate via transdermal patch for one day followed by two consecutive days without administering treatment and then repeating such dosing schedule.
  • a 48-year-old female who has been suffering from fibromyalgia for 10 years was treated in accordance with the method of the present invention.
  • the patient reported decreased pain, decreased fatigue and improved mental clarity within hours of applying the first dose of 0.2 mcg methyl 4-imidazolecarboxylate.
  • This patient has maintained has remained free of pain, and improved mental clarity while utilizing the dosing schedule of administering 0.2 mcg via transdermal patch for one day followed by two consecutive days of not administering the treatment and then repeating this one day on and two days off dosing schedule.
  • the patient has reported only two incidences of increased fatigue, which lasted only one day per incidence, and these incidences were preceded by very stressful life events.
  • the 39-year-old patient stopped the treatment for one week and during week of not using the treatment, the patient reported a decrease in libido and inability in achieving a full erection. His ability to achieve a full erection numerous times following repeated ejaculations was restored the same day that he resumed the treatment.

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US9737552B2 (en) 2010-12-14 2017-08-22 The Johns Hopkins University Treatment of cognitive impairment in a subject with a neurological autoimmune disease
EP4338740A1 (de) 2022-09-13 2024-03-20 Johannes Gutenberg-Universität Mainz Transdermales pflaster zur förderung oder beschleunigung der myelinisierung und/oder remyelinisierung

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NZ555337A (en) 2009-03-31
CA2589819A1 (en) 2007-11-23
ATE453392T1 (de) 2010-01-15
US20070276021A1 (en) 2007-11-29
EP1859800B1 (de) 2009-12-30

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